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shill for the pharmaceutical companies. Now for the truth Ruth.
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Amitriptyline Elavil. Find out the true side effects. Elavil side
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Report medication side effects to the FDA.
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Indications
In the drug management of depressive illness.
Amitriptyline may be used in depressive illness of psychotic or
endogenous nature and in selected patients with neurotic depression.
Endogenous depression is more likely to be alleviated than are other
depressive states. Amitriptyline, because of its sedative action, is
also of value in alleviating the anxiety component of depression.
As with other tricyclic antidepressants, amitriptyline may precipitate
hypomanic episodes in patients with bipolar depression. These drugs
are not indicated in mild depressive states and depressive reactions.
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Contraindications Back to top of page
In patients who have shown prior hypersensitivity to it. It should not
be given concomitantly with a MAO inhibiting compound. Hyperpyretic
crises, severe convulsions, and deaths have occurred in patients
receiving tricyclic antidepressant and MAO inhibiting drugs
simultaneously. When it is desired to substitute amitriptyline for a
MAO inhibitor, a minimum of 14 days should be allowed to elapse after
the latter is discontinued. Amitriptyline should then be initiated
cautiously with gradual increase in dosage until optimum response is
achieved.
This drug is not recommended for use during the acute recovery phase
following myocardial infarction and in the presence of acute
congestive heart failure.
See Pregnancy under Warnings.
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Warnings Back to top of page
Amitriptyline should be used with caution in patients with a history
of seizures, impaired liver function, a history of hepatic damage or
blood dyscrasias and, because of its atropine-like action, in patients
with a history of urinary retention, or with narrow-angle glaucoma or
increased intraocular pressure. In patients with narrow-angle
glaucoma, even average doses may precipitate an attack.
There has been a report of fatal dysrhythmia occurring as late as 56
hours after amitriptyline overdose.
Patients with cardiovascular disorders should be watched closely.
Tricyclic antidepressant drugs, including amitriptyline, particularly
when given in high doses, have been reported to produce arrhythmias,
sinus tachycardia, and prolongation of the conduction time.
A few instances of unexpected deaths have been reported in patients
with cardiovascular disorders. Myocardial infarction and stroke have
also been reported with drugs of this class. Therefore, these drugs
should be used with caution in patients with a history of
cardiovascular disease, such as myocardial infarction and congestive
heart failure.
Concurrent administration of amitriptyline and electroshock therapy
may increase the hazards of therapy. Such treatment should be limited
to patients for whom it is essential.
Close supervision is required when amitriptyline is given to
hyperthyroid patients or those receiving thyroid medication.
Occupational Hazards: Back to top of page
May impair mental and/or physical abilities required for performance
of hazardous tasks, such as operating machinery or driving a motor
vehicle.
Pregnancy:
There are no well-controlled studies in pregnant women; therefore, in
administering the drug to pregnant patients or women who may become
pregnant, the potential benefits must be weighed against the possible
hazards to mother and child.
Lactation:
Amitriptyline is detectable in breast milk. Because of the potential
for serious adverse reactions in infants from amitriptyline, a
decision should be made whether to discontinue nursing or discontinue
the drug.
Children:
In view of the lack of experience with the use of this drug in the
treatment of depression in children, amitriptyline is not recommended
for depressed patients under 12 years of age.
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Precautions Back to top of page
The potency of amitriptyline is such that addition of other
antidepressant drugs generally does not result in any additional
therapeutic benefit. Untoward reactions have been reported after the
combined use of antidepressant agents having varying modes of
activity. Accordingly, combined use of amitriptyline and other
antidepressant drugs should be undertaken only with due recognition of
the possibility of potentiation and with a thorough knowledge of the
pharmacology of both drugs. There has been no reports of untoward
events when patients receiving amitriptyline were changed immediately
to protriptyline or vice versa.
When amitriptyline is used to treat the depressive component of
schizophrenia, activation or aggravation of existing psychotic
manifestation may occur. Likewise, manic depressive patients may
experience hypomanic or manic episodes and hyperactive or agitated
patients may become overstimulated. Paranoid delusions, with or
without associated hostility, may be exaggerated. A reduction in dose
or discontinuation of amitriptyline may be indicated and
administration of a neuroleptic such as a phenothiazine, be considered
under these circumstances.
Seriously depressed patients should be carefully supervised. The
possibility of suicide in depressed patients remains during treatment.
Patients should not have access to large quantities of this drug
during treatment.
Discontinue the drug several days before elective surgery if possible.
Drug Interactions: Back to top of page
Amitriptyline may block the antihypertensive action of guanethidine or
similarly acting compounds.
When amitriptyline is given with anticholinergic agents or
sympathomimetic drugs, including epinephrine combined with local
anesthetics, close supervision and careful adjustment of dosage are
required. Paralytic ileus may occur in patients taking tricyclic
antidepressants in combination with anticholinergic-type drugs.
Since amitriptyline, in combination with anticholinergic type drugs,
may give rise to paralytic ileus, particularly in elderly or
hospitalized patients, appropriate measures should be taken if
constipation occurs in these patients.
Cimetidine is reported to reduce hepatic metabolism of certain
tricyclic antidepressants.
Caution is advised if patients receive large doses of ethchlorvynol
concurrently. Transient delirium has been reported in patients who
were treated with 1 g of ethchlorvynol and 75 to 150 mg of
amitriptyline.
Amitriptyline may enhance the response to alcohol and the effects of
barbiturates and other CNS depressants. Delirium has been reported
with concurrent administration of amitriptyline and disulfiram.
Note:
Included in this listing which follows are a few adverse reactions
which have not been reported with this specific drug. However,
pharmacological similarities among the tricyclic antidepressant drugs
require that each of the reactions be considered when amitriptyline is
administered.
Behavioral:
Drowsiness, fatigue, activation of latent schizophrenia,
disorientation, confusional states, hallucinations, delusions,
hypomanic reactions, disturbed concentration, nightmares, insomnia,
restlessness, agitation, excitement, jitteriness, anxiety, giddiness.
Neurological:
Epileptiform seizures, coma, dizziness, tremors, numbness, tingling,
paresthesias of the extremities, peripheral neuropathy, headache,
ataxia, alteration in EEG patterns, extrapyramidal symptoms including
abnormal involuntary movements and tardive dyskinesia, dysarthria,
tinnitus, incoordination, and slurred speech.
Anticholinergic:
Urinary retention, dilatation of the urinary tract, constipation,
paralytic ileus, especially in the elderly, hyperpyrexia, dry mouth,
blurred vision, disturbance of accommodation, increased intraocular
pressure, precipitation of latent glaucoma, aggravation of existing
glaucoma, and mydriasis.
Cardiovascular:
Quinidine-like effect and other non-specific ECG changes and changes
in AV conduction, prolonged conduction time, asystole, hypotension,
syncope, hypertension, palpitation, arrhythmias, heart block,
ventricular tachycardia, fibrillation, myocardial infarction, stroke,
unexpected death in patients with cardiovascular disorders.
Hematologic:
Bone marrow depression, including agranulocytosis, leukopenia,
eosinophilia, purpura, thrombocytopenia.
Allergic:
Skin rash, urticaria, photosensitization, edema of the face and
tongue, itching.
Gastrointestinal:
Nausea, epigastric distress, heartburn, vomiting, hepatitis (including
altered liver function and jaundice), anorexia, stomatitis, peculiar
taste, diarrhea, parotid swelling, black tongue may occur.
Endocrine:
Testicular swelling, gynecomastia and impotence in the male, breast
enlargement and galactorrhea in the female, increased or decreased
libido, elevation and lowering of blood sugar levels, syndrome of
inappropriate ADH (antidiuretic hormone) secretion.
Miscellaneous:
Weakness, increased perspiration, edema, urinary frequency, alopecia,
increased appetite, weight gain, weight loss.
Withdrawal Symptoms:
Abrupt cessation of treatment after prolonged administration may
produce nausea, headache, and malaise. Gradual dosage reduction has
been reported to produce, within 2 weeks, transient symptoms including
irritability, restlessness, and dream and sleep disturbance. These
symptoms are not indicative of addiction. Rare instances have been
reported of mania or hypomania occurring within 2 to 7 days following
cessation of chronic therapy with tricyclic antidepressants.
Aloha,
Rich
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The best defense to logic is ignorance.